Thread by @bratogram

1/8) THREAD. Six take-aways from emergency gen surgery case on pt w concern for COVID-19. Team anxiety & uncertainty so everything more difficult. Plus, lacking protocols for surgeon protection. @AnnalsofSurgery @aneelbhangu @dnepo @DrJohnScott #COVID19 #COVID19Surgery
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2/8) 1. HUDDLE FOR PREP. Extensive prep to move ICU pts w COVID-19 to OR. Huddled w ICU attd, nurse, anesthesia, RT, OR staff, enviro svs, security, & infxn ctrl. Hours of coordination (even w protocol in place). If u don't have a protocol in place, prepare one now.
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3/8) 2. LIMITED TRAINEE INVOLVEMENT. Clarified trainee rules. Residents ok, but no med students for us. No double scrubbing (unless needed) to reduce exposure & minimize junior resident movement in and out of room.
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4/8) 3. PPE DURING CASE. Donning & doffing video sent to residents in advance to review: () and cdc.gov/hai/pdfs/ppe/p…). Discussed w infxn ctrl; PPE was N95 + face shield + double gloves + leg covers + std gown.
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5/8) No PAPR as equal to well-fit N95+face shield. No respirators as N95 filters smoke (oem.bmj.com/content/73/12/… ) and droplets (jtd.amegroups.com/article/view/2…).
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6/8) 4. QUESTION OF LAPAROSCOPY. No clear guidance on laparoscopy as possible aerosol exposure. COVID in stool and GI organs (idse.net/Emerging-Disea…) so, as was equiv & faster, used open technique.
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7/8) 5. EQUIPMENT PASSED FROM OUTSIDE. Runner posted outside OR. Planned so equip readily available and no nurse movement out of room. All single-use equip (even unopened) in room thrown away at the end of case.
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8/8) 6. CAREFUL DOFFING. Removal of gown performed in OR as a team. Face mask removed outside OR or in ante room. See video/CDC pdf above.

Didn't address anesthesia, transport, OR allocation, ante rooms. Example protocols:
link.springer.com/epdf/10.1007/s…?
covid-19.uwmedicine.org/Pages/default.…

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